Military Faces of Neurosurgery – Silver Lining in the Black Cloud of the Civil War: Improved Medical Education

schGuest post from Michael Schulder, MD, FAANS
Residency Program Director
Professor and Vice Chairman, Department of Neurosurgery Director, Brain Tumor Center Hofstra
North Shore LIJ School of Medicine North Shore University Hospital
Lake Success, NY

This year marks the 150th anniversary of the end of the American Civil War. While neurosurgery was not yet a specialty during the war, there were advances in medicine which ultimately had significant impact on the emergence of the specialty starting shortly after the surrender at Appomattox. To honor this, and in conjunction with this important anniversary, we highlight the American Civil War in this Military Faces of Neurosurgery feature.

The American Civil War (1861-1865) arguably was the first modern war, a dubious distinction indeed. This conflict was the first to:

  • Rely on mechanized transport, via railroads, that moved troops and equipment in unprecedented numbers and speed;
  • Employ electronic communications, using the recently invented telegraph;
  • Use rapid firing weapons (the Gatling gun), that facilitated mass slaughter;
  • Utilize aerial reconnaissance, using hot air balloons; and
  • Introduce steam powered, armored ships (most famously the Monitor and Merrimac).

For military medicine, the Civil War was a transitional and transformative event. Notable firsts include:

  • Chloroform anesthesia;
  • Rapid transport of patients; and
  • Thorough record keeping that included photographic documentation.

civil war 2But there was no anti- or asepsis, and, of course, no antibiotics. Amputation of shattered limbs was by far the most common treatment rendered to injured soldiers during the war. It was carried out on a mass scale under conditions that seem horrific to us — and were in fact perceived as such at the time. Twice as many soldiers died of infections compared to battlefield injuries. Doctors, including surgeons, were poorly educated and trained, often learning their techniques from books only. This was a time when medicine, and certainly surgery, was more of a trade and not a scientifically based profession as we prefer to think of it now.

Once the carnage ended, American society recognized the need for improved medical education, and thus the changes that led to our current well-organized, standardized, and excellent (yes, let’s not forget that) system for training doctors. Our 19th century forebears also recognized that cleaning hands and instruments led to decreased infections and deaths, paving the way for the coming era of sterile surgical conditions.  S. Weir Mitchell used information from treating soldiers to greatly increase understanding of nerve injuries and related pain, defining the concept of “causalgia.”

Improved medical education was the faint silver lining in the black cloud of the Civil War. It made us smarter and opened the doors to our modern medical era.

Editor’s Note: Today, Nov. 19, 2015, marks the anniversary of the Gettysburg address.

civil war

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Faces of Neurosurgery — Saluting Dr. Edie Zusman: Pioneering Epilepsy Treatment in Nigeria

Sinai PictureGuest post from Sharona Ben-Haim, MD
Neurosurgical Fellow at Oxford University U.K.

In the United States, society accepts the diagnosis of epilepsy and embraces its treatment, which is usually medical, although in refractory cases may be surgical. However, for the more than 10,000,000 people on the continent of Africa who suffer from epilepsy, 75-80 percent are not treated despite the availability of efficacious and affordable medications.1,2 Unfortunately, these people fall victim not only to the treacheries of their disabling disease, but also an equally incapacitating social stigma which leaves them frightened to seek medical treatment. These patients, as well as their families, are shunned from society and may be ostracized from their communities. Epilepsy is widely believed to be the result of an evil spell or a contagious disease, which may even prevent a person from helping or even touching someone who has fallen during a seizure.


Dr. Edie Zusman (far left)

In 2012, neurosurgeon, Dr. Edie Zusman, along with John Obegolu, Director of the Neuroscience Medical/Surgical Nursing at Eden Medical Center in Castro Valley, California, created the Nigeria Epilepsy Care Advancement Program (NECAP) to try and address Nigerians beset by epilepsy. By August of 2013, a group of physicians, nurses, and volunteers from Northern California set out to treat 100 patients between the ages of 16 and 80 at the RISE Clinic in the Anambra state of Nigeria. They provided antiepileptic medications to those patients in need and arranged for monthly patient follow-up with the clinic. In addition to directly treating patients, they structured an alliance that included pharmaceutical companies and government agencies to create a sustainability program for future procurement of medications at affordable prices. They worked diligently to educate the community, including speaking directly to patients, performing interviews on radio and television, building awareness of both the disease process and its manifestations, and providing citizens in the community an avenue for assistance. “Most villagers believe it is a form of witchcraft,” said Mr. Obegolu. “Epileptics are shunned by society and forbidden to marry or even to hold jobs. Many people in Africa still believe that epilepsy is the result of some crime committed by their ancestors or the result of a voodoo spell.”

NECAP went beyond the single mission in August 2013. They also:

  • Established a five year initiative aimed at advancing epilepsy care in Southeastern Nigeria;
  • Designed an ongoing education program for the local healthcare providers at the RISE clinic, as well as specialists in the community and other parts of Nigeria; and
  • Hold a monthly teleconference to discuss refractory and otherwise difficult cases with the healthcare providers in Nigeria.

NECAP has extended beyond the patients of the RISE clinic; thus laying the groundwork to change the cultural stigma of epilepsy. Their work allows patients and providers to feel emboldened to speak publicly about this disease process, making headway for more patients to get treatment and to receive acceptance and support from their local communities. The RISE clinic is now a center of excellence in Nigeria for the evaluation and treatment of individuals with epilepsy. They continue to expand their impact on the local community and are working collaboratively with the National Hospital in Abuja to encourage further education. “We laid the foundation to achieve the collaborative goal of treating not only the patients in our clinic, but rather the 2 million patients in Nigeria with epilepsy,” said Dr. Zusman, “with the ultimate goal of making meaningful and transformative change for the lives of people in Nigeria.”

We are proud of the face that Dr. Zusman and her colleagues have put forth both in their local community and abroad. Their creative patient-centric approach to treating epilepsy in Nigeria reinforces the important role that neurosurgeons play in creating a collaborative environment for the care of all neurosurgical diseases.

To learn more, visit here.


  1. WHO Epilepsy Fact Sheet
  2. Epilepsy in Africa
Posted in Access to Care, Faces of Neurosurgery, Guest Post, Health | Tagged , , , , , , |

Service as a Neurosurgeon: My Mentors as the Military Face of Neurosurgery

rocCol (ret) Rocco A. Armonda, MD, FAANS; Director of Neuroendovascular Surgery for MedStar Washington Hospital Center and MedStar Georgetown University Hospital; Director of Neurosurgery at the Uniformed Services University of the Health Sciences.
Washington, DC

A man should be judged by the “dust on his sandals and not the polish on his boots.

During the recent visit by Pope Francis to our nation’s capital, I was reminded about the connection to serve a higher purpose. These inspiring words by the pope brought to mind all the incredible examples I have of mentors in my career that embodied service. Throughout a career of 31 years from my days as a young cadet at West Point in 1982 until my retirement from active duty service in 2013, I have been inspired, mentored and taught by many individuals who lead lives of service.

Thoralf M. Sundt, MD

SundtThoralf M. Sundt, MD, West Point Class of 1952, was one of my earliest neurosurgery and military mentors. As a young infantry officer who just graduated from the academy, Dr. Sundt was awarded the Silver Star for Valor during the Korean War for his bravery at the Battle of Pork Chop Hill (where he also lost two of his closest classmates Dick Shea and Dick Inman). He later became one of the most accomplished cerebrovascular neurosurgeons and shaped the future landscape for excellence in complex neurovascular microsurgery. As a young medical student in 1989, I rotated to the Mayo Clinic and watched him operate and teach. Despite an advanced stage of multiple myeloma afflicting his spine — which required him to wear a rigid body cast while operating — he never missed his weekly Saturday morning conferences.

In 1992, shortly before he died, he was awarded the Distinguished Graduate Award by West Point. The message of his memorable lecture titled, “You Are Here For Discipline-Not Justice,” has stayed with me for over 23 years. He told the remarkable story about astronaut Frank Borman, USMA Class of 1950, defending his group of fellow cadets who had returned late from Christmas leave due to a snowstorm grounding their DC-3. “The Ace,” senior regimental tactical officer (the youngest infantry regimental commander from WWII) was nonplused. His response was, “you are here for discipline and not justice.” All were punished accordingly. Sundt’s message was clear, life is not fair and it is discipline that carriers the day.  Discipline is the factor that gives one strength to complete the mission despite fatigue, obstacles and the seemingly impossible.

Richard G. Ellenbogen, MD

ellenbogenDuring residency at Walter Reed LTC (ret) Richard G. Ellenbogen, MD, FAANS, embodied service, dedication and true leadership to me. Dr. Ellenbogen’s personal example of service and dedication to each individual patient provided a model of what a military neurosurgeon was about. Deployed during Desert Storm in 1990-91, with a wife and newborn at home, he operated in the desert without a CT scanner, drills or basic neurosurgical equipment. This would become a founding lesson of “far-forward” service that would be required of an entire generation of military residents he trained. We would all find ourselves in a similar situation a decade later in both Iraq and Afghanistan. Dr. Ellenbogen did more than train us, he shaped the future of military neurosurgery to confront the challenges of tomorrow’s wars. His efforts created the small cadre of neurosurgeons who would become “far-forward” combat neurosurgeons for the next generation, and he passed the mantle of leadership to Col (ret) James M. Ecklund, MD, West Point Class of 1983, who served as the next Chair at Walter Reed and expanded the model of service. Dr. Ecklund would lead from the front, literally volunteering for both Iraq and Afghanistan while many other military personnel were working hard to avoid deployments! Dr. Ellenbogen not only prepared us for the future unknown, but connected us to the legacy of our past, including one of our then still living founders Hugo Rizzoli, MD. One of his most impressionable quotes he shared with me came from a little book of Russian poetry by Yevgeny Yevtushenko: “…Forgive no error you recognize, it will repeat itself, increase, and afterwards our pupils will not forgive in us what we forgave.

Hugo V. Rizzoli, MD

Dr RizzoliHugo V. Rizzoli, MD, was a living legend for me — the veritable “Godfather” of neurosurgery in Washington, DC — and thanks to Dr. Ellenbogen’s introduction I was able to enjoy his company for many years until his death in December 2014. Dr. Rizzoli’s accomplishments and contributions to the military and neurosurgery are many. He was the last resident trained by Walter E. Dandy, MD, and one of the first neurosurgeons to bring this art to Washington, DC. There he served as chair of neurosurgery at Walter Reed during the last year of WWII and remained as a civilian consultant for over a generation, shaping the leadership, training and care at Walter Reed throughout that entire era. This ensured that the best and brightest candidates were trained and that care was maintained at the highest level. He trained nearly two generations of neurosurgeons from his service in the Army and as chairman of the department of neurosurgery at George Washington University. We would meet for dinner at his favorite Italian restaurants in Bethesda, MD and he would share with me remarkable stories about neurosurgery through the past 70 years! Although technology had dramatically changed, the unending dedication to service linked this generation of military and civilian neurosurgeons to the same mission that moved Dr. Rizzoli. I was able to share his company with my family, residents and colleagues so they also will benefit from the wisdom of his life. He was an example and inspiration for all.

Voluntary Military Neurosurgeons as Heroes

teffDuring the recent conflicts, I have had the opportunity to witness amazing service and dedication from multiple volunteer neurosurgeons who have answered the call to duty. One of the most impressive has been my former partner LTC (ret) Richard T. Teff, MD, FAANS who continues to serve as a neurosurgeon for the Army as a civilian employee. Dr. Teff was the longest deployed neurosurgeon in the U.S medical corps, serving over two years as a neurosurgeon in a combat zone! This is SERVICE! It comprised four standard six-month tours, which he performed a year at a time, both served in Iraq during some of the most critical phases. In the combat theater he was tireless and courageous, frequently traveling “outside the wire” with civilian affairs teams to Iraqi hospitals. There he worked educating, training and aiding Iraqi neurosurgeons in the care of the multitudes of civilian patients. On his own, without any support from the Army, he organized an enormous book donation program between Thieme and the Iraqi neurosurgeons during the first year of the war. He personally transported multiple severely brain injured patients on some of the first Critical Care Air Transport flights from Iraq to Germany. After this, he created the first of its kind neurotrauma curriculum for the CCAT teams, trauma teams and battalion surgeons. The Army recognized his efforts with a Bronze Star for Service.

bakkenWith no prior military obligation, Hans E. Bakken, MD, FAANS volunteered to serve only if he could deploy in the combat zone. This was unheard of! This occurred during some of the worst casualties of the Iraq war. As a small force of active Army neurosurgeons, we overwhelmingly welcomed his contribution without which, some of would have faced our second or third rotations. His service demonstrated the greatest dedication of our nation’s civilian-military volunteers. Not waiting to be called, but rather going forward and answering the call. What a different society we would have today if that was the rule rather than the exception.

Future Mentors

Military neurosurgery service continues as the baton passes from one generation to the next at Walter Reed. Col (ret) Leon Moores, MD, FAANS (deployed twice) and Col (ret) Michael K. Rosner, MD, FAANS (deployed to Iraq), who were both former chairs at Walter

Dr. Randy Bell

Dr. Randy Bell

Reed, have recently retired. Currently returning from deployment are tomorrow’s leaders:

  • LTC Sven M. Hochheimer, MD (USAF)
  • LTC Michael S. Dirks, MD (USA)
  • CDR Randy S. Bell, MD, FAANS (USN)
  • CDR Christopher J. Neal, FAANS (USN) (present program director)

All are former Walter Reed graduates who complete the military neurosurgery lineage that stretches from Walter Dandy, MD through Hugo Rizzoli, MD, to the present. As their former teacher, I so often became the student as they questioned the conventional “status-quo” response and collaborated to chart new horizons in quality care for our patients and their families.

I honor my mentors by continuing the tradition of teaching and training. I train future Walter Reed rotating residents at Washington Hospital Center, a Level I trauma center in Washington, DC and at the Comprehensive Stroke Center. I try to advance our art by being there for our “brothers” through service in some of the most hostile of environments:  To train, to inspire, and to honor those who have gone before me and the generation that now carries on.

Dr. Sundt eloquently concluded his message at West Point in 1992 with words that ring as true now as then:

As the shadows lengthen, our class ages and the ranks are thinned, returning to our beloved and hallowed alma mater becomes more of a pilgrimage than a reunion. We restore our faith, rekindle our love, gather our strength, and muster our courage for what lies ahead from just being here. Remember and be proud that there is no higher calling than service to country…Vaya con Dios.

Today, on Veterans Day, I offer praise for all these aforementioned mentors who have shaped my career as enormously deserving Military Faces of Neurosurgery.

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